Provider Demographics
NPI:1548967078
Name:MED A QUEST PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:MED A QUEST PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBIECH
Authorized Official - Suffix:
Authorized Official - Credentials:SENIOR DIRECTOR
Authorized Official - Phone:609-646-2479
Mailing Address - Street 1:6814 TILTON RD STE G
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-4490
Mailing Address - Country:US
Mailing Address - Phone:609-573-3001
Mailing Address - Fax:
Practice Address - Street 1:6814 TILTON RD STE G
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4490
Practice Address - Country:US
Practice Address - Phone:609-573-3001
Practice Address - Fax:609-646-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6614400Medicaid